Dermatologists advise people to be smart about relaxing in the sun. / Saul Loeb, AFP/Getty Images

by Kim Painter, Special for USA TODAY

by Kim Painter, Special for USA TODAY

Wear your sunscreen, seek the shade, wear protective clothing and never, ever go to a tanning salon. Despite decades of repetition, many of us fail to follow that skin-saving advice - and a new study shows that's true even for people who have had the most serious form of skin cancer.

More than a quarter of people who have had melanoma say they never use sunscreen, according to the study presented at a medical meeting Monday. Even greater numbers eschew hats and long sleeves, and 2% admit they have used a tanning bed in the last year, say researchers from Yale University, who presented the data at the annual meeting of the American Association for Cancer Research in Washington, D.C.

Cancer survivors are a bit more careful than the rest of us: 32% always wear sunscreen, while just 17% of other adults do. Overall, they also are more likely to wear hats and long sleeves and stay in the shade. But when compared with others with the same age, race and insurance coverage, the differences are only significant when it comes to sunscreen use, says researcher Anees Chagpar. In other words, a 40-year-old white person with insurance coverage who has been through cancer treatment is just as likely to use a tanning bed or go outside without a wide-brimmed hat as one who has not.

Chagpar, a cancer surgeon, says she finds the data on indoor tanning especially "shocking and concerning." She says the findings raise questions about whether some people might be "addicted" to tanning.

The study of nearly 27,000 people included 171 who said they had a history of melanoma, which, like other skin cancers, is linked to sun exposure and indoor tanning. It is most common in people with fair skin and a history of sunburns, and it can run in families. It will kill about 9,000 people in the USA this year, according to the non-profit Skin Cancer Foundation.

Survivors are nine times more likely than other people to have melanoma in the future, so experts advise them to take their skin protection seriously.

Several previous studies have suggested such vigilance is hard to maintain, though some studies do find better compliance than the latest survey does, says Mary Tripp, a behavior researcher at the University of Texas MD Anderson Cancer Center in Houston. A possible weakness of the new survey, which has not yet been published, is that it relies on self-reported medical histories, which are sometimes inaccurate, she says.

But she says she has interviewed melanoma survivors who have let down their guard.

"When someone is first diagnosed, they are practicing sun protection, but as the years go by, maybe they tend to fall back on their old habits," she says. "A lot of melanoma survivors have told me that it is very important for them to maintain a normal outdoor lifestyle."

Dermatologists don't want melanoma survivors or the rest of us to stay indoors all the time, says Ali Hendi a dermatologist in Chevy Chase, Md., and a spokesperson for the Skin Cancer Foundation.

Anyone who wants to garden, golf or walk outside should do it, but "be smart about it," he says, by staying out of the midday sun and using shade, sunscreen and protective clothing.

"You can't change your genetic makeup, you can't change the kind of skin you have and you can't change previous sunburns," but you can lower your risk, even if you have already had skin cancer, he says.

Still, those who don't follow that advice have plenty of company, Hendi says: "There are smokers who still continue to smoke after being diagnosed with lung cancer. There are a lot of people in our society who do things they know are not good for them."

Addiction and denial can play roles in such behaviors, but a lack of complete information may, too, Chagpar says. She says doctors and health educators may need to do a better job of telling people how and why to protect themselves.